Postoperative poverty; The hidden surgical dilemma

Abstract

A term describing the financial difficulty experienced by sick people after surgical procedures, postope-rative poverty, remains poorly understood but it is a severe outcome of surgical care in low- and middle-income countries (LMICs). Surgery, though life-saving, mostly causes catastrophic out-of-pocket spending which puts families in a bad economic position. This editorial addresses the maladies of oversight in the financial incomes of surgical planning in LMICs. On the basis of the data obtained in Uganda, Sierra Leone, and Tanzania, we demonstrate that trans-portation, lost wages, rehabilitation, and longer hospital stays are paid by the patients, even in case they have been treated in a publicly accessible/subsidized facility, which contributes to their medical impoverishment. Such economic aftershocks are highly felt by women and entrench the cycle of intergenerational poverty. Even though the world has promoted Universal Health Coverage (UHC), postoperative rehabilitative treatment and financial risk coverage are glaringly missing in most surgical policies. The traditional focus on surgical volume at the expense of financial safety has to be changed. We call for the inclusion of post-surgery care and financial protections into the basic surgical service package and UHC programs. Policymakers should understand that recovery following surgery is not clinical but it is economic as well.

Keywords

• Postoperative Poverty
• Financial Fallout Post-Surgery
• Global Surgery
• Systemic Neglect

Ameliyat sonrası yoksulluk; Cerrahinin gizli ikilemi

Abstract

Ameliyat sonrası yoksulluk, cerrahi müdahalelerden sonra hastaların yaşadığı mali zorlukları tanımla-yan bir terim olarak tam olarak anlaşılamamış olsa da, düşük ve orta gelirli ülkelerde (DMOÜ) cerrahi bakımın ciddi bir sonucudur. Ameliyat, hayat kurtarıcı olsa da, çoğunlukla aileleri ekonomik olarak zor durumda bıra-kan felaket düzeyinde cepten harcamalara neden olur. Bu yazı, DMOÜ'lerde cerrahi planlamanın mali gelirlerindeki denetimsizlik sorunlarını ele almaktadır. Uganda, Sierra Leone ve Tanzanya'da elde edilen verilere dayanarak, ulaşım, kaybedilen ücretler, rehabilitas-yon ve daha uzun süreli hastane kalışlarının, kamuya açık/sübvansiyonlu bir tesiste tedavi edilmiş olsalar bile hastalar tarafından karşılandığını ve bunun da tıbbi yoksullaşmalarına katkıda bulunduğunu gösteriyoruz. Bu tür ekonomik artçı sarsıntılar kadınlar tarafından yoğun bir şekilde hissedilmekte ve nesiller arası yoksulluk döngüsünü derinleştirmektedir. Dünya, Evrensel Sağlık Kapsamını (UHC) teşvik etmiş olsa da, ameliyat sonrası rehabilitasyon tedavisi ve finansal risk teminatı çoğu cerrahi poliçede açıkça eksiktir.

Keywords

• Ameliyat sonrası yoksulluk
• mali yoksunluk
• sistemik ihmal

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